Nokea
The nurse is caring for a patient with diabetes who has been admitted with pneumonia and is prescribed gentamicin 60 mg IV. Which of the following parameters should the nurse monitor to evaluate the patient for adverse effects of the medication?
- A. Urine osmolality
- B. Serum potassium and sodium
- C. Blood glucose level
- D. Blood urea nitrogen (BUN) and creatinine
Correct Answer: D
Rationale: When a patient at risk for chronic kidney disease (CKD) receives a nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in determining the effect of the gentamicin.
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The nurse is caring for a patient with a left arm arteriovenous fistula. Which of the following actions should the nurse include in the plan of care to maintain the patency of the fistula?
- A. Check the fistula site for a bruit and thrill.
- B. Assess the rate and quality of the left radial pulse.
- C. Compare blood pressures in the left and right arms.
- D. Irrigate the fistula site with saline every 8-12 hours.
Correct Answer: A
Rationale: The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.
Which of the following parameters is most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation?
- A. Heart rate
- B. Blood urea nitrogen (BUN) level
- C. Urine output
- D. Creatinine clearance
Correct Answer: C
Rationale: Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a litre an hour. The other data will be monitored but are not the most important determinants of fluid infusion rate.
The nurse is teaching a patient with stage 5 chronic kidney disease (CKD) about management of CKD. Which of the following patient statements indicate that the teaching was effective?
- A. I need to try to get more protein from dairy products.
- B. I will try to increase my intake of fruits and vegetables.
- C. I will measure my urinary output each day to help calculate the amount I can drink.
- D. I need to take the erythropoietin to boost my immune system and help prevent infection.
Correct Answer: C
Rationale: The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.
The nurse is caring for a patient who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration. Which of the following findings is most important for the nurse to report to the health care provider?
- A. The blood urea nitrogen (BUN) level is 23.1 mmol/L.
- B. The creatinine level is 186 mcmol/L.
- C. Urine output over an 8-hour period is 2500 mL.
- D. The glomerular filtration rate is -3 mL/minute/1.73 m^2.
Correct Answer: C
Rationale: The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy.
The nurse is caring for a patient who has had an insertion of an arteriovenous graft (AVG) in the right forearm and has symptoms of pain and coldness of the right fingers. Which of the following actions should the nurse take?
- A. Elevate the patient's arm above the level of the heart.
- B. Report the patient's symptoms to the health care provider.
- C. Remind the patient about the need to take a daily low-dose Aspirin tablet.
- D. Educate the patient about the normal vascular response after AVG insertion.
Correct Answer: B
Rationale: The patient's complaints suggest the development of distal ischemia (steal syndrome) and may require revision of the AVG. Elevation of the arm above the heart will decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts.